The Surgical Intervention for Traumatic Injury Scale: A Clinical Tool for Traumatic Brain Injury.

• Type of Material: Article
• Authors: Eric A. Sribnick, Nationwide Children's Hospital; Michael Lunney, Emory University; David W Wright, Emory University; Jason W. Allen, Emory University; Patricia Hudgins, Emory University; Junxin Shi, Nationwide Children's Hospital; Krista Wheeler, Nationwide Children's Hospital; Jeffrey R. Leonard, Nationwide Children's Hospital; Sanjay S. Dhall, University of California San Francisco; Henry Xiangh, Nationwide Children's Hospital
• Language: English
• Date: 2019-07
• Publisher: eScholarship Publishing, University of California
• Publication Version: Final Published Version
• Copyright Statement: © 2019 Sribnick et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.5811/westjem.2019.4.41802
• Title of Journal or Parent Work: Western Journal of Emergency Medicine
• ISSN: 1936-900X
• Volume: 20
• Issue: 4
• Start Page: 578
• End Page: 584
• Keywords: Glasgow Coma Scale; surgical decompression; traumatic brain injury; ProTECT III; radiography; computed tomography (CT); craniotomy; Surgical Intervention for Traumatic Injury (SITI); pupil examination; craniectomy; surgical intervention
• Research Categories: Biology, Neuroscience; Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management

Abstract

Introduction: There is no widely used method for communicating the possible need for surgical intervention in patients with traumatic brain injury (TBI). This study describes a scoring system designed to communicate the potential need for surgical decompression in TBI patients. The scoring system, named the Surgical Intervention for Traumatic Injury (SITI), was designed to be objective and easy to use. Methods: The SITI scale uses radiographic and clinical findings, including the Glasgow Coma Scale Score, pupil examination, and findings noted on computed tomography. To examine the scale, we used the patient database for the Progesterone for the Treatment of Traumatic Brain Injury III (ProTECT III) trial, and retrospectively applied the SITI scale to these patients. Results: Of the 871 patients reviewed, 164 (18.8%) underwent craniotomy or craniectomy, and 707 (81.2%) were treated nonoperatively. The mean SITI score was 5.1 for patients who underwent surgery and 2.5 for patients treated nonoperatively (P<0.001). The area under the receiver operating characteristic curve was 0.887. Conclusion: The SITI scale was designed to be a simple, objective, clinical decision tool regarding the potential need for surgical decompression after TBI. Application of the SITI scale to the ProTECT III database demonstrated that a score of 3 or more was well associated with a perceived need for surgical decompression. These results further demonstrate the potential utility of the SITI scale in clinical practice.